Provider Demographics
NPI:1417300955
Name:LEE PESKY LEARNING CENTER
Entity Type:Organization
Organization Name:LEE PESKY LEARNING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLOHESSY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:208-333-0008
Mailing Address - Street 1:3324 W ELDER ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-4713
Mailing Address - Country:US
Mailing Address - Phone:208-333-0008
Mailing Address - Fax:
Practice Address - Street 1:3324 W ELDER ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-4713
Practice Address - Country:US
Practice Address - Phone:208-333-0008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSE-202926251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health